Amplify Health
Healthcare
SeniorClaimsOperationsSpecialist
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“Senior Claims Operations Specialist at Amplify Health. Skills: Claims operations, Provider management, Process optimisation, Stakeholder engagement. Develop and implement in-market strategy. Identify opportunities to enhance efficiency”
What You'll Achieve.
Enhance operational efficiency; Increase straight-through processing; Reduce manual effort; Enhance adjudication accuracy; Measure value realisation; Optimize value in delivery; Streamline claims workflows; Stay at forefront of innovation; Focus on cost efficiency; Support improvement cycles; Ensure seamless claims operations; Ensure alignment with standards; Ensure alignment with regulations; Foster culture of innovation; Ensure smooth adoption; Close operational gaps; Detect, prevent, mitigate FWA; Continuously refine detection models; Track value delivery; Operationalise provider agreements; Strengthen provider risk mitigation; Capture value
Industry & Context.
Root cause analysis; Data-driven decision making
What They're Looking For.
Must Have
Over 7 years of experience, Experience leading claims transformation, Experience leveraging automation, Familiarity with claims adjudication platforms, Familiarity with FWA detection tools, Familiarity with data-driven operations design
Nice to Have
Prior experience in consulting, Medical degree, Health science MBA, Advanced degree
What You'll Do.
Develop and implement in-market strategy
Identify opportunities to enhance efficiency
Drive initiatives to increase STP
Collaborate to design and deploy solutions
Collaborate to ensure alignment
Work to deploy AI-driven solutions
Oversee integration of analytics tools
Evaluate emerging technologies
Partner with insurtech vendors
Lead transformation of claims processes
Implement best-practice frameworks
Translate business requirements
Engage with regulators
Engage with providers
Collaborate with client stakeholders
Adapt processes and SOPs
Lead organizational change efforts
Provide training and support
Communicate transformation goals
Identify and close operational gaps
Deploy AI-enabled solutions
Collaborate to refine detection models
Recommend enhancements to audit frameworks
Oversee tracking of value delivery
Partner to design and embed solutions
Translate provider requirements
Conduct workflow observations
How You'll Work.
Team & Collaboration
Cross-functional teams; Client stakeholders; Product teams; Technology teams; Data teams; Underwriting teams; Actuarial teams; Provider management teams; Customer service teams; Special Investigation Units; Analytics teams
Communication Scope
Translate business requirements; Communicate transformation goals
Full Job Description
**Do meaningful work with us. Every day.** At Amplify Health, we’re looking for individuals with ambition, resilience and passion for healthcare, insurance, wellness and digital technology. As a fast-growing business with the ambition of making people and communities across Asia healthier, we have exciting career opportunities available to help us achieve our vision. Based in Hong Kong and reporting to the Claims Operations Lead, the Claims Operations Specialist is responsible for implementing Amplify Health’s in‑market strategy for claims operations solutions. The role serves as a critical interface between client relationships, external stakeholders, including providers and regulators, and internal stakeholders to align transformation efforts with industry standards and requirements. Key to success in this role will be the ability act the key conduit between the numerous business stakeholders and technical teams to translate complex business needs into actionable operational, process, and technology solutions for clients. As Claims Operations Specialist, Hong Kong, at Amplify Health you will play a key role in shaping the future of Hong Kong’s claims management process. You will be working with some of the largest healthcare payors in the country, as well as providers and regulators to leave a lasting impact on the industry. **Responsibilities** **Strategy Development & Execution** * Partner with the Claims Operations Lead to develop and implement an in‑market strategy that drives end‑to‑end transformation of claims operations and claims risk management. * Identify opportunities to enhance operational efficiency through organisational redesign, process optimisation, automation, and technology adoption. * Drive initiatives to increase straight-through processing (STP), reduce manual effort, and enhance adjudication accuracy. * Track key KPIs to measure value realisation and operational effectiveness. **Technology and Innovation:****** * Collaborate with AH’s produc
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